Skin care for Premature Neonates

SteveNNP, MSN, NP · Jan 16, 2007

We only put our

babynurselsa, RN · Jan 16, 2007

I have worked at couple of places that we initiated an aquaphor protocol.

http://www.kidsource.com/kidsource/content3/news3/skin.baby.html

http://www.nichd.nih.gov/cochrane/SOLL7/SOLL.HTM

By the second study they were looking at whether there might be an increased incidence of infection. Some said that there was decreased incidence some said more. Personal experience that I had it worked very well and we did not have an increase in infection rates.

Sweeper933 · Jan 16, 2007

We have standing orders for any baby

preemieRNkate, RN · Jan 16, 2007

We put our little ones in humidity. Also, no leads or temp probes at first, and we back the pulse ox with tegaderm so it doesn't actually stick to the baby's skin. Minimal tape, etc. We also use sheepskin.

justjenny · Jan 19, 2007

we back the pulse ox with tegaderm so it doesn't actually stick to the baby's skin.

That is a great idea! I have never heard of this practice and I will have to mention this at work!

We use humidity x 2 weeks and aquaphor...same as mentioned above. Very low infection rate overall in our unit so I do not believe this is a factor for infection.

We also "trim" our leads, etc. for a very tiny baby so they do not have so much adhesive all over their body. I watched a show on Discovery health last night and this poor little baby had more tape on its head than I have EVER SEEN! (2 huge strips of tape to hold eye protection for bili lights, huge stips of tape for ETT and big strip to hold an OG in...poor baby...)

Jenny

mom to a PRINCESS · Jan 19, 2007

We actually just got these new limb leads that I absolutely love! They are wonderful for the micropreemies. They are much smaller than the typical chest leads and just wrap around the arms and leg. We don't use the aquaphor protocol in our NICU. We put tegaderm on the chest, arms, legs of babies

RainDreamer, BSN, RN · Jan 20, 2007

We've gotten some great new products over the last year that are GREAT for the skin of the tiny ones. We use the mepitac tape and something else (I'll have to find out the name when I go back to work next week), that we use as a base for everything (temp probe, pulse ox, IV's, NCPAP, etc). They're just awesome, as they don't PULL the skin off, they just peel off very easily.

Sweeper933 · Jan 21, 2007

We also use the limb bands here and they are great. They are more sensitive to artifact at times though. We also trim down the pulse-ox probe and other things of that nature. We will use tegaderm underneath things as needed as well. All of our babies get sheepskins to lay on. The only problem w/ using high humidity, is that things tend to not stick for very long. It's always a constant battle between adhereing things enough so that they will outlast the humidity - but not on there so strong that it takes skin off with it when removed.

wensday, MSN, RN, APN, NP · Jan 23, 2007

We have humidity for under 28 weeks I think, the tiny ones get all hot and steamy.

We use Cavilon spray under all adhesives as it makes them stick really well but doesn't take the skin off. We do things like dot cotton wool balls onto ECG leads to take some sticky off.

We put Duoderm on the skin -eg around Servo (skin temp) probes in a keyhole type way- and blenderm over the top of that, so the blenderm sticks to the duoderm. We do stick blenderm to the skin for OGTs on vented babies that drool and unstick the tape as it seems more practical.

Any breaks in the skin we put duoderm or mepitel on them depending on location and severity. Extravasation wounds get massive peices of duoderm that get changed and photographed weekly. E45 cream goes on dry skin, Orobase on broken down buttocks (like on withdrawing babies). Chlorhexadine powder gets applied to axillas, umbilicus and groins to prevent infection.

ETTs are held in place with stabilisers that are really pliable and tied onto vent hats that the local elderly knit for us to our pattern with ties and a flap for CUSS!!

Think that's bout it but I think we are pretty good on that kind of thing.

Our NICU boss is a bigwig in neo skin!

Jes RN · Jan 28, 2007

On our unit, all infants

lovemyjob · Jan 30, 2007

we are in the process of getting 21 of the giraffe beds. We have 2 now, and we use it on the micros with humidity. One of our new neos brought a new set of policies. It is called the "tiny baby initiative." Our first policy change has been to cover the trunk and limbs with bioclusive dressings and let them fall of on their own. It is suppose to help with temp control, insensible water loss, and electrolyte balance, as well as protecting the skin. We have stopped using the aquaphor becasue of fear in infection. We also use the limb leads on ocassion. Last night I cared for a 25 week EGA. I am not sure if the limb leads on his left arm were ever adjusted. I found him last night with pretty severe breakdown at the lead site. The good thing about the bioclusive dressings is that you can place chest leads on top of it.